Onyx embolization of an intraosseous pseudoaneurysm of the middle meningeal artery in a patient with meningiomatosis, McCune-Albright syndrome, and gray platelet syndrome

Abstract

<jats:p>A 13-year-old boy with meningiomatosis, McCune-Albright syndrome, and gray platelet syndrome presented with an enlarging “lump” on his right forehead. A head CT scan revealed a polyostotic fibrous dysplasia involving the entire skull. A 3.4-cm right frontal osseous cavity and an overlying right forehead subcutaneous soft-tissue mass were seen, measuring 5.2 cm in diameter and 1.6 cm thick. Ultrasound of the cavity and overlying mass showed swirling of blood and an arterialized waveform. MRI revealed an en plaque meningioma underlying the cavity. An intraosseous pseudoaneurysm fed by 3 distal anterior division branches of the right middle meningeal artery (MMA) with contrast extravasation was found on angiography. Two MMA feeders were embolized with Onyx, with anterograde filling of the intraosseous cavity with Onyx. A small pocket of residual intracavity contrast filling postembolization from a smaller third MMA feeder eventually thrombosed and the forehead lump regressed.</jats:p>

Mycotic Pseudoaneurysm Associated with Skull Base Osteomyelitis Treated with Endovascular Embolization

“…Pseudoaneurysm of the MMA are rare, typically occurring secondary to trauma. As of March 2016, approximately 27 cases of non-traumatic pseudoaneurysm of the MMA have been reported in the medical literature [ 1 ]. No true guidelines currently exist regarding treatment.…”

“…No true guidelines currently exist regarding treatment. In previous cases, treatment had included craniotomy with ligation, resection, and endovascular techniques [ 1 ]. Positive results have been reported following both embolization and surgical resection of MMA pseudoaneurysm [ 3 ].…”

“…Nontraumatic pseudoaneurysms of the middle meningeal artery (MMA) are rare, with approximately 27 cases having been reported as of March 2016 [ 1 ]. Formation of these pseudoaneurysms has been associated with various states of increased hemodynamic stress, such as Paget’s disease, meningiomas, arteriovenous malformations, Moyamoya disease, neurofibromatosis type II, cavernous hemangioma of the skull, and post aneurysm coiling [ 1 ]. However, pseudoaneurysms of the MMA associated with local spread of infection have yet to be reported in the medical literature.…”

Co-existing of craniofacial fibrous dysplasia and cerebrovascular diseases: A Series of 22 Cases and Review of the Literature

“…The most common locations affected are the craniofacial bones, proximal femur, and rib[2], with the craniofacial region involved in 90% of the PED and MAS cases and the anterior cranial base involved in over 95% of these cases [3]. Depending on the type and location of FD, the signs and symptoms vary and include facial deformity and asymmetry, vision changes, hearing impairment, nasal congestion and/or obstruction, pain, paresthesia, and malocclusion.Vascular abnormalities complicating FD has been reported in several case reports [4][5][6][7][8][9][10], suggesting that although there was no known common etiology, these two kinds of entities might be related to some extent. However, there was no literature focusing on the co-existence of craniofacial brous dysplasia (CFD) and cerebrovascular diseases (CVD), considering that the number of patients with CFD is pretty limited.…”

“…Vascular abnormalities complicating FD has been reported in several case reports [4][5][6][7][8][9][10], suggesting that although there was no known common etiology, these two kinds of entities might be related to some extent. However, there was no literature focusing on the co-existence of craniofacial brous dysplasia (CFD) and cerebrovascular diseases (CVD), considering that the number of patients with CFD is pretty limited.…”